going from synthroid/cytomel to erfa

[blueeyedmaggie]

Hi gang,

Ive been on 112 synthroid and 10 of cytomel for about a year and have just received a scrip from my gp  for erfa from my gp.  The problem is my gp doctor is not an expert on dosing and transitioning so I've come to you.

latest labs
tsh 0.16
t4free  10 (12-22)
free t3  4 (2.6-5.7)

Do I start at 60 mg and then move up or start at 90?  I'm on my own with this (I do see a endo but she does not prescribe ndt so will likely drop me if I start) so I'm looking to you for your best practices.

[gimel]

Yes, you need to increase your Synthroid dosage to raise your Free T4 to at least the middle of the range.  That will likely require at least going to a dosage of 150 mcg of Synthroid.  I think I would raise it in two steps to get to 150.  You also need to increase your Cytomel.  I'd say raising your dosage to 15 mcg would be a good step and then after 6 weeks or so, go back for re-test of both FT3 and FT4.  

Regarding the suppressed TSH, you will hear lots of scary things from doctors who don't know that it is a regular occurrence when taking adequate doses of thyroid med.  They will tell you that it will cause hyper reactions, heart palpitations, and also cause osteoporosis.  Wrong.  TSH is a pituitary hormone that reacts to changes in levels of the biologically active thyroid hormones, Free T3 and Free T4.  The purpose of TSH is to stimulate the thyroid gland.  Just logically, how can the absence of a hormone (TSH) cause these things?  If won't, unless it is accompanied by excessive levels of Free T3 and Free T4, which you certainly don't have.  

There are scientific  studies that conclude that a suppressed TSH is a regular occurrence when taking thyroid medication.  This is a link to related info that I posted some time ago for another member.  

http://www.medhelp.org/posts/Thyroid-Disorders/TSHsymptoms-not-numbers/show/2379736#post_11538925

[blueeyedmaggie]

Is it okay to suppress tsh that much?

[blueeyedmaggie]

thanks for the information.  I actually go see my endo tomorrow. She will not prescribe the erfa and may not be happy about the tsh number.

However my gp is another matter.

So in your opinion do you think I should yp both my synthroid and cytomel doses then?

[gimel]

If it were me, I would want to raise the level of Free T4 and Free T3, by increasing your Synthroid and Cytomel.  Free T4 needs to be around the middle of its range, at minimum, and Free T3 needs to be in the upper part of its range, as necessary to relieve symptoms.  Your results are a long way from there.  The reason I would just stick with the Synthroid and Cytomel is that you can increase the doses independently, dependent on whether you need more T4 or T3.  With Erfa, you get a fixed ratio of T4 to T3.  If that gave you the levels you need, fine, but it is much easier to adjust them separately with the Synthroid and Cytomel.  There is no special magic to Erfa, or the other NDT types of med.  It is just a matter of getting your FT3 and FT4 to optimal levels.  

In addition, it is very important for Vitamin dD, B12 and ferritin to be at adequate levels.  It is good that you are supplementing with iron to raise your ferritin level.  What are your actual Vitamin D and B12 levels?  I want to make sure they are optimal, not just within range.  

I am also happy to see that your doctor is willing to prescribe T3 med, and also to ignore your suppressed TSH level.  That is the right thing to do for you.  Not too many members we hear from in Canada are able to find a doctor that will do that.  

[blueeyedmaggie]

vit d b12 are good, I'm still working on ferritin.   Up to 59 from 20 and feeling much better.  
Im still having all the hypp symptoms, esp fatigue.  Could sleep 9 hours a night plus a 2 hour nap of I could.  Not doable as a single mom half time time with a full time job.  

I just went on the erfa site and from their conversion numbers it might be best to start between 2-3 30 mg pills per day.

What do you think?

[gimel]

Before discussing dosage after a switch, I'd like to ask why you felt the need to make the change.  If it is because you were still having hypo symptoms, that would be easy to explain, since your Free T4 and Free T3 levels are still too low in the range for many hypo patients.  Many of us say that symptom relief required Free T3 in the upper part of its range and Free T4 at the middle of its range.  Also, it is very important for a hypo patient to get their Vitamin D, B12 and ferritin to optimal levels.  

[blueeyedmaggie]

looks like I might have to take 6 of the 30 pills to get to 108mcgs of t4.  Does that sound correct?